Effect of acute psychosocial stress on the brain-derived neurotrophic factor in humans - a randomized cross within trial.

The brain-derived neurotrophic factor (BDNF) is involved in the plasticity and development of the central nervous system. Thereby the protein synthesis is highly related to neuronal activity, and its signaling pathways are associated with several substances like, e.g. glucocorticoids, which seem to be able to activate BDNF-Tropomyosin receptor kinase B (TrkB). While there is evidence that acute physical stress can result in advantageous physiological outcomes like an enhanced BDNF level, outcome parameters in response to psychosocial stress are primarily focused on psychological parameters. The existing literature pointing on the impact of acute psychosocial stress on physiological parameters is controversial and differs depending on the species, the stressor used, and the study methodology. It was hypothesized that an acute standardized psychosocial stressor would increase the BDNF level and therefore show beneficial physiological outcome parameters through psychosocial stress. The serum BDNF levels of 32 healthy young males (M = 24.31 years of age, SD = 3.35), who performed the Trier Social Stress Test (TSST), were assessed and compared to a control condition. To prove the stress-generating effect of the TSST, additional cortisol levels were measured. Acute psychosocial stress significantly increased the serum BDNF- and the cortisol-level, whereby no alteration was found during the control. This study expands the rare literature focusing on the effect of an acute standardized psychosocial stressor on the BDNF level in healthy humans, including a control condition. Implications for future studies are being discussed.

Effects of psychosocial and physical stress on lactate and anxiety levels.

Both intense physical activity and potent psychosocial stressors increase blood lactate. Raising lactate levels by infusing the chemical can have an anxiogenic effect. Here, we compare the relationship between changes in lactate and anxiety levels resulting from two standardized stressors. We investigated the effects of the Multiple Wingate All-Out Performance Test (WG), a strong physical stressor, and the Trier Social Stress Test (TSST), a well-documented psychosocial stressor, in 32 healthy young men using a crossover design. Before and after each stressor, venous blood was analyzed for lactate levels and the State-Trait-Anxiety Inventory (STAI) was given. Both stressors raised both lactate and anxiety significantly above their baseline levels. While the rise in lactate was much higher for the WG than for the TSST, the rises in anxiety were nearly equal. Individual fitness did not influence the results for lactate or anxiety. No significant relation between lactate and anxiety changes were found. Thus, our results as well as the literature suggest that lactate is an important variable for understanding the impact of sport participation.

Physical versus psychosocial stress: effects on hormonal, autonomic, and psychological parameters in healthy young men.

As a time-efficient training system, high intensity interval training (HIIT) is well known for several beneficial effects. However, the literature on the stress-generating effects of HIIT shows a research deficit. A standardized comparable stressor and different kinds of stress-parameters are needed for quantifying the results. The present study examined the hormonal, autonomic, and psychological stress outcomes of HIIT compared to a standardized psychosocial stressor and tested the cross-stressor-adaptation (CSA) hypothesis which implies a stress-buffering effect at a good fitness level. In a sample of 32 healthy young males (24.31 ± 3.35 years of age) stress was induced with a multiple Wingate (WG), as a HIIT all-out performance test, involving four 30 sec all-out exercise bouts. In addition, the Trier Social Stress Test (TSST), which consists of a mock job interview and mental arithmetic performance, was used for stress induction. Cortisol, heart rate variability (HRV), and stress-related questionnaires were assessed before, during, and after stress induction. Both the Wingate as well as the TSST led to a highly significant change in time and stressor for cortisol and HRV. Furthermore, a significantly higher delta during Wingate was identified. In part, the TSST had a significantly higher impact on the psychological measurements than the WG. In contrast to the literature, this study was not able to confirm the stress-buffering effect of the CSA hypothesis. These findings prove the stressful effect of HIIT. The prevention of negative health effects needs to be taken into consideration in sports training methods and programs as well as in stress-related research Lay summary By using a well-estimated psychosocial stressor for comparison and several stress parameters, this study is able to show the strong stress-generating effect of high intensity interval training (HIIT). Interestingly, subjective stress perception differed from objective stress response. This research is an important step towards understanding stress-related disorders in elite sport and making recommendations for reducing autonomic as well as hormonal stress in high intensity sport.

Evaluating nurse understanding and participation in the informed consent process.

BACKGROUND: Informed consent is fundamental to the autonomous decision-making of patients, yet much is still unknown about the process in the clinical setting. In an evolving healthcare landscape, nurses must be prepared to address patient understanding and participate in the informed consent process to better fulfill their well-established role as patient advocates. RESEARCH OBJECTIVE: This study examines hospital-based nurses' experiences and understandings of the informed consent process. RESEARCH DESIGN: This qualitative descriptive study utilized a semi-structured interview approach identifying thematic concerns, experiences, and knowledge of informed consent across a selected population of clinically practicing nurses. PARTICIPANTS AND RESEARCH CONTEXT: In all, 20 baccalaureate prepared registered nurses practicing in various clinical settings (i.e. critical care, oncology, medical/surgical) at a large northeastern academic medical center in the United States completed semi-structured interviews and a demographic survey. The mean age of participants was 36.6 years old, with a mean of 12.2 years of clinical experience. ETHICAL CONSIDERATIONS: Participation in this study involved minimal risk and no invasive measures. This study received Institutional Review Board approval from the University of Pennsylvania. All participants voluntarily consented. FINDINGS: The majority of participants (N = 19) believe patient safety is directly linked to patient comprehension of the informed consent process. However, when asked if nurses have a defined role in the informed consent process, nearly half did not agree (N = 9). Through this qualitative approach, three major nursing roles emerged: the nurse as a communicator, the nurse as an advocate, and the clerical role of the nurse. DISCUSSION AND CONCLUSION: This investigation contributes to the foundation of ethical research that will better prepare nurses for patient engagement, advance current understanding of informed consent, and allow for future development of solutions. Nurses are at the forefront of patient-provider interactions and they are often presented opportunities to learn about and engage in the informed consent process.

Improving Patients' Experiences Communicating With Nurses and Providers in the Emergency Department.

INTRODUCTION: As health care becomes increasingly patient centered, organizations strive to improve patients' ratings of satisfaction with care. Communication with nurses and providers drives overall satisfaction, yet little evidence exists to guide them in ensuring effective communication in the emergency department. METHODS: A semistructured interview guide based on the Hospital Consumer Assessment of Healthcare Providers survey was used to elicit qualitative data from 30 patients seen in the emergency department and fast track regarding communication with nurses and providers. Data were analyzed using content analysis methodology. RESULTS: Two types of overarching themes emerged. Foundational themes include behaviors that convey courtesy and respect and are required for participants to view their interactions with nurses and providers as positive. Interactive themes describe humanistic ways in which nurses and providers conveyed courtesy and respect, reassurance through careful listening, attentiveness, and explaining things in an understandable way. DISCUSSION: The findings underscore existing evidence regarding patients' perceptions of being treated with courtesy and respect via nurses' and providers' use of positive verbal phrasing and nonverbal body language. They reveal new insights into the importance of specific communication behaviors used by nurses and providers during interactions. Treating patients as individuals amidst a fast-paced care environment, proactively recognizing and responding to patients' fears and concerns, and explaining information clearly to ensure understanding were critical.

Development of a Comprehensive Geriatric Assessment Led by Geriatric Nurse Consultants: A Feasibility Study.

Hospitalized older adults are at high risk for complications, leading to negative outcomes such as longer lengths of stay, hospital readmissions, and functional and cognitive decline. Comprehensive Geriatric Assessment (CGA) models are effective in mitigating these syndromes but are not widespread. Nurses with expertise in gerontology who can provide consultation and care coordination can improve care processes and clinical outcomes. This pilot study capitalized on the role of the geriatric nurse consultant (GNC) to develop, implement, and test the feasibility, acceptability, and utility of a GNC-led CGA. Through repeated applications with hospitalized patients, this study demonstrated that GNCs could complete a CGA and identify clinically actionable findings. This study also uncovered clinical geriatric concerns that would not have otherwise been identified via traditional nursing assessments. The results highlight contribution of a GNC-led CGA as a mechanism to support care process improvements to address common geriatric concerns in the acute care setting. [Journal of Gerontological Nursing, 44(12), 25-34.].

Treatment Fidelity of the Family-Centered Function-Focused Care Intervention.

The purpose of the current study was to evaluate treatment fidelity (i.e., the extent to which an intervention is provided as intended) in the Family-Centered Function-Focused Care (Fam-FFC) intervention. This was a descriptive study using data collected during intervention activities throughout the course of the Fam-FFC study. Specific measures included Environment and Policy Assessments, Fam-FFC Knowledge Test, Goal Attainment Scale, Function-Focused Care Behavior Checklist, and completion of the FamPath Audit. Delivery was provided as intended. Staff demonstrated intervention skills with only one Fam-FFC research nurse needing retraining. Receipt was based on Fam-FFC Knowledge Test scores >80%, with the majority of participants reporting goal achievement as expected or higher than expected and slight improvement in environments and policies to better support Fam-FFC. Lastly, enactment was based on evidence that in 67% of observations staff provided at least one function-focused care intervention. Findings from this study will be used to adapt the intervention to reach all staff, increase ways to change environments and policies, consider ways to more comprehensively evaluate enactment of function-focused care during real-world interactions, and consider the characteristics of nursing staff and whether a relationship exists between staff characteristics and providing function-focused care. [Research in Gerontological Nursing, 16(4), 165-171.].

Interventions for preventing back pain among office workers - a systematic review and network meta-analysis.

OBJECTIVE: Back pain is common in the working population. This systematic review with network meta-analysis (NMA) aimed to compare the effects of interventions for preventing back pain among office workers. METHODS: We searched eight databases and additional sources up to March 2021. We included randomized controlled trials (RCT) and cluster RCT focusing on office workers, comparing work-related interventions aimed at preventing back pain (defined as pain in any part of the spine) to a control condition and assessing back pain and/or work absence. Further outcomes considered were adverse events and participants' satisfaction. We performed both frequentist and component NMA. Risk of bias (RoB) was evaluated using RoB 2 and certainty of the evidence (CoE) was assessed using GRADE. RESULTS: We screened 9809 records and included 24 studies with a total of 7080 participants. RoB was assessed as "some concerns" or "high" for all studies and outcomes. Included studies investigated multicomponent interventions, ergonomics, physical activity, education, behavioral interventions and no/minimal interventions. Effects were mostly not statistically significant and based on low/very low CoE. Physical activity probably reduces days of work absence slightly [mean difference (MD) -1.10, 95% confidence interval (CI) -2.07- -0.13], and combining physical activity and ergonomics may reduce back pain intensity (standardized MD -0.41, 95% CI -0.80- -0.02) when compared to no/minimal intervention. A large proportion of participants were satisfied with the interventions, adverse events were rarely assessed. CONCLUSIONS: We observed mostly minor effects of interventions on back pain and work absence among office workers. The practical relevance of these effects is questionable.

Training-induced alterations of skeletal muscle mitochondrial biogenesis proteins in non-insulin-dependent type 2 diabetic men.

This study investigates whether regular physical activity (moderate endurance or resistance training twice a week for 3 months) influences the key regulatory molecules of mitochondrial biogenesis (peroxisome proliferator-activated receptor gamma coactivator-1α (PGC1α), nuclear respiratory factor-1 (NRF1), and mitochondrial transcription factor A (TFAM)) in patients suffering from non-insulin-dependent type 2 diabetes mellitus (T2DM) (n = 16, years = 62 ± 7, body mass index (BMI) = 30 ± 4 kg/m(2)). Seven T2DM men took part in endurance training, and 9 men participated in resistance training. BMI-matched non-diabetic male control subjects (CON) (n = 7, years = 53 ± 6, BMI = 30 ± 4 kg/m(2)) were studied for comparison. The protein contents of PGC1α, NRF1, and TFAM were determined using immunohistochemical staining methods on biopsies taken from the musculus vastus lateralis. At baseline, no differences were observed in NRF1-density between the T2DM men and the CON, while the contents of PGC1α and TFAM were decreased in the T2DM men. PGC1α and TFAM contents were not changed in the T2DM patients after the training period, but NRF1 was decreased. The down-regulation of mitochondrial signaling molecules might explain the patho-physiological reduction in mitochondrial biogenesis found in T2DM. Physical training, as performed in our study, did not reverse the down-regulation of mitochondrial signaling molecules--at least not after 3 months. [corrected].

Secondary Traumatic Stress Among Labor and Delivery Nurses.

PURPOSE: To describe the prevalence and severity of secondary traumatic stress (STS) among labor and delivery nurses within a Northeastern United States academic health system. STUDY DESIGN AND METHODS: Using a cross-sectional, descriptive correlational design, a convenience sample of labor and delivery nurses (288 nurses) were invited to complete Secondary Traumatic Stress Scale (STSS), a 17-item Likert-type instrument, that measures intrusion, avoidance, and the arousal symptoms associated with indirect exposure to traumatic events. Five additional questions about potential consequences of STS were also asked. RESULTS: N = 144 completed the survey (50% response rate). Average STSS score was 33.74 (SD, 11.8), with 35% of respondents meeting symptom severity scores associated with STS. STSS Scores ≥ 38 were significantly correlated with nurses considering leaving their jobs, calling out sick, or requesting an assignment change after witnessing a traumatic birth (p < 0.001). The majority of respondents (84.7%) reported witnessing a traumatic birth. After witnessing a traumatic birth, respondents used co-workers, family, and friends as sources of support. CLINICAL IMPLICATIONS: This study offers insight into the frequency and severity of STS among labor and delivery nurses, as well as the potential workforce-related consequences and provides a foundation for future work aimed at developing interventions to prevent or alleviate STS.

Moral Distress: Identification Among Inpatient Oncology Nurses in an Academic Health System.

BACKGROUND: Moral distress occurs when clinicians know the morally correct action to take but are unable to follow through because of internal and external constraints. It is associated with negative consequences, such as burnout, decreased job satisfaction, avoidance, and turnover. OBJECTIVES: The purpose of this study was to describe the frequency and level of moral distress among inpatient oncology nurses and to identify possible associations among nurses' demographic characteristics, work experience, and moral distress levels. METHODS: Ninety-three inpatient oncology nurses from a large academic health system completed the Moral Distress Scale-Revised (MDS-R). Additional questions included intent to leave and requests for changes in patient assignments because of moral distress. FINDINGS: Years as a nurse, changing or considering changing patient assignments, and changing care provided to a patient because of moral distress were statistically significantly associated with higher MDS-R scores. Participants reported using palliative care consultations, pastoral care, and social work to assist with their moral distress.

Improving Nonvocal Critical Care Patients' Ease of Communication Using a Modified SPEACS-2 Program.

OBJECTIVE: To evaluate the feasibility and impact of implementing the "study of patient-nurse effectiveness with assisted communication strategies-2" (SPEACS-2); a program to facilitate communication with nonvocal patients. STUDY DESIGN: The plan-do-study-act quality improvement methodology guided the implementation of a modified SPEACS-2 program within a pre and posttest design. The Ease of Communication Scale (ECS) measured patients' communication difficulty, and care processes measured the program's success. STUDY POPULATION: Nurses (N = 385) across 5 intensive care units were trained in SPEACS-2. We assessed 354 nonvocal patients (aged 18-95 years) requiring continued mechanical ventilation after withdrawal of heavy sedation. Patients were evaluated over one 2-week preintervention (n = 163) and two 3-week postintervention periods (n = 128; n = 63). A subsample of intervention patients (n = 204) completed the ECS. RESULTS: Ease of Communication Scale scores improved significantly (p = .027) from baseline (mean 25.86 ± 12.2, n = 71) to postintervention period 2 (21.22 ± 12.2, n = 63). Nurses' use of communication techniques and compliance with communication plans of care incrementally increased after training. CONCLUSIONS: Implementing SPEACS-2 demonstrated positive changes in patients' ease of communication and feasibility of incorporating evidence-based communication strategies into practice.